The apparent outward symptoms of Parkinson’s are easily diagnosed by a doctor but there is no blood test or brain scan that can confirm the diagnosis. If a person does not respond to the drugs used to treat Parkinson’s then the underlying cause could be some other movement disorder having similar symptoms. A doctor can determine the difference by doing some additional tests.
The most effective and standard treatment for Parkinson’s is through drugs and are aimed to restore the proper balance of the neurotransmitters acetylcholine and dopamine by increasing the dopamine levels. Medicine is usually started when your symptoms become disabling or disrupt your daily activities. However, as the disease worsens, implantation of a brain stimulator may be considered.
Medication for treatment of Parkinson’s disease
The following medications are used to control the symptoms of Parkinson’s.
Levodopa or L-Dopa is the most commonly prescribed drug for Parkinson’s. The body metabolizes it to produce dopamine. Levodopa is used in conjunction with a related drug called carbidopa as giving dopamine directly is ineffective as the brain’s natural defense blocks it from being used by the body. The combination of carbidopa with Levodopa is called Sinemet helps to suppress nausea and other possible side effects.
Doctors prefer to postpone the starting of Levodopa as long as possible as the drug tends to lose its effectiveness over time. However, it has also been found that the sooner the person suffering from Parkinson’s is given Levodopa, the more beneficial it is. Research is being conducted to find ways to offset the loss of its effectiveness.
MAO-B inhibitors also block the action of an enzyme that breaks down dopamine. They may be taken alone early in Parkinson's disease or with other drugs as the disease progresses. MAO-B inhibitors include selegiline (Eldepryl) and rasagaline (Azilect). They are usually used alone, because combining them with other drugs can cause unwanted side effects. They work by helping to conserve the amount of dopamine available by preventing the dopamine from being destroyed.
Dopamine agonists are dopamine-like drugs that directly imitate dopamine's activity in the brain. Pramipexole (Mirapex), rotigotine (Neuropro), and ropinirole (Requip) used alone or in combination with L-dopa treat the motor symptoms of Parkinson's disease. These drugs activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.
Other medications prescribed for Parkinson's disease include apomorphine, benztropine, amantadine, selegiline, and anticholinergic drugs; all can help control various symptoms -- in some cases by releasing dopamine from nerve cells, in others by reducing the effects of acetylcholine, a neurotransmitter that can cause a drop in dopamine.
It is important to follow the doctor’s instructions when one takes medications for Parkinson’s disease. Medicines should not be increased, decreased or stopped without consulting a doctor as it may cause big changes in the symptoms. Sometimes one feels that the medicines are not working but stopping them altogether can make the symptoms become worse.
Food intake and medications
The medications used for Parkinson's can themselves cause nutrition-related side-effects, such as nausea and poor appetite. Typically, these side-effects are most severe when a medication is first prescribed but some individuals have continuing problems with them. Eating a small snack (such as ginger ale and a few crackers) along with medications may help to control these side-effects.
Some medicines for Parkinson's disease don't work as well if taken with food that has protein in it, such as meat or cheese. The protein can block the medicine and keep it from working as well as it should.
Other treatments for Parkinson’s Disease
- Instead of trying to correct the neuro-transmitters imbalance with drugs, neurologists and neurosurgeons have found ways of grafting dopamine-producing cells in the brain of those with Parkinson’s disease. There is research using stem cells for this purpose.
- Globus Pallidus or thalamus is a part of the brain involved in Parkinson’s disease and through surgical techniques lesions are created in this part. A more effective Deep Brain Stimulation has replaced this treatment in which a wire is placed inside the brain in the specific location depending on the symptoms that need to be treated.
- Research is being conducted to use the glial cell derived nerve growth factor to Parkinson’s and other neurodegenerative diseases. This substance is produced naturally by tissues throughout the body. Some investigations have also indicated that injections of this nerve growth factor may help in preserving and restoring nerve cells in the brain and spinal cord.
- There are various treatments that focus on the effects of the disorder rather than the causes. A physical therapist may be consulted to restore normal body alignment, enhance balance and motor responses. Muscle strengthening exercises can be undertaken to improve the ability to initiate motion, help in speaking and swallowing.
Parkinson’s patients may lose their confidence for interacting with others and may become socially isolated. This lack of social activities can lead to depression. It is therefore important to ensure that symptoms of depression are recognized and treated. Here are a few tips:
- Regular exercise and balanced diet
- Enough sleep
- Engage in social activities
- Stay active
Want more information, please see our additional posts as part of our month-long series dedicated to information regarding Parkinson’s Disease (Please create a blog category for Parkinson’s Disease and hyperlink to the category here), diagnoses, treatment, prevention and care.